Provider Demographics
NPI:1689787434
Name:LEVENSON, MARVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:LEVENSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 KIETZKE LN
Mailing Address - Street 2:SUITE C122
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5033
Mailing Address - Country:US
Mailing Address - Phone:775-823-9133
Mailing Address - Fax:775-823-9240
Practice Address - Street 1:4600 KIETZKE LN
Practice Address - Street 2:SUITE C122
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5033
Practice Address - Country:US
Practice Address - Phone:775-823-9133
Practice Address - Fax:775-823-9240
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY074103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPHD74Medicare ID - Type Unspecified